title: Outcomes of early versus late intestinal operations in patients with gastroschisis and intestinal atresia: results from a prospective national database.
abstract: BACKGROUND
  Gastroschisis may be complicated by intestinal atresia, necrosis, and/or perforation. In the absence of an urgent indication, intestinal procedures are often delayed to allow for bowel recovery. This practice has not been evaluated.
  
  
  METHODS
  We queried a prospective Canadian database of all patients with gastroschisis born between 2005 and 2011. Patients with intestinal atresia who underwent an intestinal operation during the first 21 days of life (EARLY GROUP) were compared with those who underwent operations later (LATE GROUP).
  
  
  RESULTS
  Of 629 gastroschisis patients, 78 (12.4%) had intestinal complications; 27 patients (4.3%) had intestinal operations for atresia without necrosis or perforation - 14 EARLY and 13 LATE. Baseline clinical parameters were similar between the two groups. There was a decreased incidence of the following complications in the EARLY group but none reached statistical significance: post-operative bowel obstruction (28.6% vs. 61.5%, p = 0.1); line sepsis (14.3% vs. 30.8 %, p = 0.4); and wound infection (14.3% vs. 46.1%, p = 0.1). Earlier tolerance of enteral feeding in the EARLY group was manifested by younger age at first enteral feeding (14.8 + 2.6 vs. 44.7 + 7.4 days, p = 0.002) and higher tolerance of enteral feeding at 28 days of life [less patients exclusively on TPN (28.6% vs. 61.5%, p = 0.06), and more patients on more than 50 cc kg(-1)day(-1) of enteral feeding (42.9% vs. 7.7%, p = 0.08)].
  
  
  CONCLUSIONS
  Early intestinal operations in patients with gastroschisis and intestinal atresia are not associated with increased complications, and allow patients to receive and tolerate enteral feeding earlier.
authors.affiliation: Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada H3H 1P3.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Alshehri
authors.forename: Sherif
authors.initials: S
authors.lastname: Emil
authors.forename: Jean-Martin
authors.initials: JM
authors.lastname: Laberge
authors.forename: Erik
authors.initials: E
authors.lastname: Skarsgard
mesh_terms: D000015:Abnormalities, Multiple / Q000401:mortality / Q000601:surgery*; D016208:Databases, Factual; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D020139:Gastroschisis / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007409:Intestinal Atresia / Q000401:mortality / Q000601:surgery*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D016896:Treatment Outcome
keywords: Complex; Gastroschisis; Intestinal atresia; Outcomes; Timing of surgery